Acute Distal Radius Fractures Research Articles

Acute Distal Radius Fracture: PAF Analysis

Acute Distal Radius Fracture: PAF Analysis

Treatments for acute and old distal radius fracture with lunate dislocation

Our study was undertaken to determine the correct treatment protocol for distal radius fracture with lunate anterior dislocation. From 2000 to 2007, 58 patients (36 with acute injury and 22 with old injury) with distal radius fracture with lunate anterior dislocation were enrolled in the study. Among acute injury patients, 15 were treated through manipulative reduction and plaster fixation and 21 were treated through minimal invasive poking reduction followed by Kirschner wire and plaster fixation. Among old injury patients, 8 underwent operative reduction of lunate dislocation through the palmar approach and Kirschner wire and plaster fixation, whereas 14 patients underwent operative reduction and fixation through the dorsal approach combined with reparation of the dorsal radiolunate ligament. Lidstrom wrist function scores and the morbidity of lunate necrosis and osteoarthritis were documented and evaluated. Lidstrom wrist function scores revealed that the rate of excellent and good scores was higher in acute injury patients than in old injury patients (91.7 versus 54.5%, respectively; P=0.018). The lunate necrosis rate was lower in acute injury patients than in old injury patients (0 versus 27.2%, respectively; P=0.027). For old injury patients, the lunate necrosis rate was higher in those treated with the palmar approach than in those treated with the dorsal approach (50 versus 14.3%, respectively; P=0.033). The key points for resolving distal radius fracture with lunate dislocation are prompt and precise diagnosis and treatment of lunate dislocation to prevent old lunate dislocation. We recommend that the surgical procedure is performed through the dorsal approach with reparation of the dorsal radiolunate ligament.

TREATMENT WITH OR WITHOUT INTERNAL FIXATION FOR ULNAR STYLOID BASE FRACTURES ACCOMPANIED BY DISTAL RADIUS FRACTURES FIXED WITH VOLAR LOCKING PLATE

The purpose of this study was to evaluate the treatment results, with and without internal fixation of ulnar styloid base fractures associated with acute distal radius fractures. A total of 48 patients were enrolled, including 20 patients treated by internal fixation (fixation group) and 28 treated without internal fixation (non-fixation group). The evaluated parameters were postoperative range of motion, grip strength, DASH score, and the presence or absence of ulnar wrist pain over time. The outcome was assessed as "excellent" in 15 patients of the fixation group and 21 patients of the non-fixation group, and "good" in five patients of the fixation group and seven patients of the non-fixation group. There were no significant differences in the clinical outcomes or any of the parameters at the final evaluation between the two groups. However, the grip strength was significantly better in the non-fixation group than in the fixation group until 12 weeks postoperatively. The overall clinical outcome was good in both groups, with no significant difference between the groups.

Supracondylar Radial Nerve Block for Treatment of Distal Radius Fractures in the Emergency Department

Background Patients with acute distal radius fractures are frequently treated in the emergency department (ED) with closed reduction and splinting. Many of the anesthesia methods frequently employed may either lack efficacy or require additional monitoring and resources. Case Report An 18-year-old woman presented to the ED with a dorsally angulated distal radius fracture (Colles fracture). As an alternative to procedural sedation, an ultrasound-guided block of the radial nerve proximal to its bifurcation into the deep and superficial branches was performed. The resulting anesthesia was adequate to reduce and splint the fracture with minimal discomfort for the patient. Conclusion Ultrasound-guided supracondylar block of the radial nerve proximal to the origin of the deep and superficial branches provides safe and efficacious anesthesia for distal radius fracture reduction in the ED.

Re: Scheer JH, Hammerby S, Adolfsson LE. Radioulnar ratio in detection of distal radioulnar joint instability associated with acute distal radius fractures. J Hand Surg Eur. 2010, 35: 730–4

Re: Scheer JH, Hammerby S, Adolfsson LE. Radioulnar ratio in detection of distal radioulnar joint instability associated with acute distal radius fractures. J Hand Surg Eur. 2010, 35: 730–4

Relationship between distal radius fracture malunion and arm-related disability: A prospective population-based cohort study with 1-year follow-up

BackgroundDistal radius fracture is a common injury and may result in substantial dysfunction and pain. The purpose was to investigate the relationship between distal radius fracture malunion and arm-related disability.MethodsThe prospective population-based cohort study included 143 consecutive patients above 18 years with an acute distal radius fracture treated with closed reduction and either cast (55 patients) or external and/or percutaneous pin fixation (88 patients). The patients were evaluated with the disabilities of the arm, shoulder and hand (DASH) questionnaire at baseline (concerning disabilities before fracture) and one year after fracture. The 1-year follow-up included the SF-12 health status questionnaire and clinical and radiographic examinations. Patients were classified into three hypothesized severity categories based on fracture malunion; no malunion, malunion involving either dorsal tilt (>10 degrees) or ulnar variance (≥1 mm), and combined malunion involving both dorsal tilt and ulnar variance. Multivariate regression analyses were performed to determine the relationship between the 1-year DASH score and malunion and the relative risk (RR) of obtaining DASH score ≥15 and the number needed to harm (NNH) were calculated.ResultsThe mean DASH score at one year after fracture was significantly higher by a minimum of 10 points with each malunion severity category. The RR for persistent disability was 2.5 if the fracture healed with malunion involving either dorsal tilt or ulnar variance and 3.7 if the fracture healed with combined malunion. The NNH was 2.5 (95% CI 1.8-5.4). Malunion had a statistically significant relationship with worse SF-12 score (physical health) and grip strength.ConclusionMalunion after distal radius fracture was associated with higher arm-related disability regardless of age.

Radioulnar Ratio in Detection of Distal Radioulnar Joint Instability Associated With Acute Distal Radius Fractures

Lesions of the triangular fibrocartilage complex (TFCC) are commonly associated with distal radius fractures and may adversely affect the functional outcome. This prospective study evaluated computed tomography, using the radioulnar ratio (RUR), to detect laxity of the distal radioulnar joint in 48 consecutive patients with acute distal radius fractures and compared the results with a radioulnar stress test. We found the clinical stress test to be reliable in chronic cases, but the RUR method of questionable value in both acute and chronic cases.

“PAF” analysis of acute distal radius fractures in adults. Preliminary results

There is not enough evidence in the literature to support the use of any treatment in distal radius fractures, mainly because of the heterogeneous aspects of most series. There is a need for more standardized analyses of distal radius fractures that should allow the identification of more homogeneous groups of patients. The authors propose a novel synthetic method to analyse acute distal radius fractures in adults. A one-page chart includes criteria related to the patient (P), the energy of the accident (A), and the characteristics of the fracture (F) along with associated ulnar and carpal lesions. The preliminary results of the use of this chart in 258 consecutive patients are presented. Four homogeneous groups of patients are described and the principles of their treatment are discussed.

Hand Numbness and Carpal Tunnel Syndrome after Volar Plating of Distal Radius Fracture

We report the incidence of late onset post-operative carpal tunnel syndrome (late carpal tunnel syndrome) and late median nerve neuropathy after volar plating of distal radius fracture by conducting a retrospective study on volar plating for distal radius fracture performed during 2002 to 2006. Two hundred eighty-two volar plating were performed for acute distal radius fracture after exclusion. Post-operative hand numbness occurred in 24 patients of which nine had carpal tunnel syndrome. Thus, the incidence of late carpal tunnel syndrome was 3.2% (9/282). Of the eight (8/24, 33%) patients with post-operative hand numbness that failed to respond to conservative treatment, five had carpal tunnel release and three had neurolysis of median nerve at distal forearm. All had clinical improvement except in one patient. The incidence of late carpal tunnel syndrome after volar plating of distal radius in the present series is similar to the prevalence of carpal tunnel syndrome in general population. The incidence is low compared with other series, regardless of treatment method (conservative treatment, volar or dorsal plating). The outcome of post-operative hand numbness is generally favourable.

Treatment of Extra-Articular Distal Radial Malunions With an Intramedullary Implant

Malunited distal radius fractures pose considerable problems, especially for young, active individuals. Surgical correction with osteotomy, bone grafting, and internal fixation with plates and screws has been the treatment of choice. Locked intramedullary fixation is an alternative technique to provide bony stability while minimizing soft tissue irritation in the management of acute distal radius fractures, with acceptable clinical results. The purpose of this study was to describe our experience with the use of an intramedullary device combined with grafting to repair distal radial malunions. This fixation device is inserted through the radial styloid and obtains distal fixation with 3 fixed-angle locking screws. Thirteen patients underwent distal radius malunion repair with an intramedullary implant and grafting. There were 6 male and 7 female participants with an average age of 51 years (range, 18-72 y). Patients were evaluated at an average follow-up of 24 months (range, 13-38 mo). Clinical outcome was measured by range of motion of the wrist and forearm, and grip strength, and by using the Disabilities of the Arm, Shoulder, and Hand questionnaire. We analyzed radiographs to determine time to union and adequacy of correction. All of the malunions healed, with an average time to healing of 11 weeks. Patients' average range of motion at follow-up was 56 degrees of flexion, 66 degrees extension, 85 degrees pronation, and 84 degrees supination. Mean grip strength was 83% of the unaffected side, and the average Disabilities of the Arm, Shoulder, and Hand score was 21. Radiographs taken on the latest follow-up showed correction to the following average parameters: 20.6 degrees radial inclination, 11.0 mm radial height, +1.0 mm ulnar variance, and 2.1 degrees volar tilt. The technique presented in this report demonstrates the effectiveness of an intramedullary nail combined with bone graft or graft substitute in repairing malunited fractures of the distal radius. The results show reliable correction of the deformity and good functional outcomes. Therapeutic IV.

L’index sagittal articulaire (ISA) pour l’analyse des fractures fraîches du radius distal

Displacements of articular fragments are not always visible on initial radiographs of acute distal radius fractures. Despite the wide use of CT scan, it may be useful to know a simple index that could suggest an articular displaced fracture from the initial standard radiographs. The authors describe an articular sagittal index (ASI) of the distal radius and provide reference values from a study of 100 healthy volunteers. An increase of the ASI index suggests a displaced articular distal radius fracture with possible impaction.

Tendon Entrapment in Distal Radius Fractures

We retrospectively defined the rate and clinical features of tendon entrapment in 693 consecutive patients with 701 distal radius fractures treated in a single hospital. Eight extensor tendons and one flexor tendon were entrapped. All fractures with extensor tendon entrapment were palmarly displaced (Smith type) or epiphyseal. Flexor tendon entrapment was seen in dorsally angulated (Colles type) epiphyseal fracture. The rate of tendon entrapment in acute distal radius fractures was 1.3%. Extensor tendon entrapment in palmarly displaced fractures is more common.

Tendon Entrapment in Distal Radius Fractures

We retrospectively defined the rate and clinical features of tendon entrapment in 693 consecutive patients with 701 distal radius fractures treated in a single hospital. Eight extensor tendons and one flexor tendon were entrapped. All fractures with extensor tendon entrapment were palmarly displaced (Smith type) or epiphyseal. Flexor tendon entrapment was seen in dorsally angulated (Colles type) epiphyseal fracture. The rate of tendon entrapment in acute distal radius fractures was 1.3%. Extensor tendon entrapment in palmarly displaced fractures is more common.

Reliability and Validity of the German Version of “The Patient-rated Wrist Evaluation (PRWE)” as an Outcome Measure of Wrist Pain and Disability in Patients with Acute Distal Radius Fractures

The aim was to test the reliability and validity of the German version of the Patient-rated Wrist Evaluation (PRWE) for patients with acute distal radius fractures. To estimate the reliability and construct validity, 44 patients completed a questionnaire booklet containing the German PRWE, the Short Form-36 (SF-36), and the Disability of the Arm, Shoulder, and Hand (DASH) four to six weeks after the fracture, and the PRWE again seven days later. For reliability, the intraclass correlation coefficient (ICC) was 0.94 for the PRWE total score. Its internal consistency was 0.89 (Cronbach's alpha). The PRWE total score showed a moderate correlation with the DASH (0.62) and the SF-36 subscale bodily pain (0.58). Low correlations were found with other scales of the SF-36. Based on our results the German PRWE is a practical, reliable, and valid instrument and can be recommended to measure patient-rated pain and disability in German-speaking patients with acute distal radius fracture.

The Reliability of Measurements Taken from Computer-Stored Digitalised X-Rays of Acute Distal Radius Fractures

Sixteen observers measured eight anatomical parameters on digitalised images of six acute distal radial fractures using the Patient Archiving Communication System software and repeated the measurements at least 2 weeks later. Inter- and intraobserver reliability was calculated using intraclass correlation coefficients and tolerance limits. The highest interobserver agreement was demonstrated in the dorsal tilt (intraclass correlation coefficient 0.858; tolerance limit 14.2 degrees ). When compared with the results of a study looking at observer reliability in measurement of healed distal radial fractures, the reliability of computerised measurements is not significantly different from those achieved by manual techniques (dorsal tilt interobserver tolerance limits on computer system 16 degrees , compared to 15 degrees using ruler and protractor). These results suggest that the recommended radiological reduction limits for distal radius fractures of <10 degrees change in palmar tilt, <2 mm radial shortening, <5 degrees change in radial angle and a <1 to 2 mm articular step cannot be reliably measured.

Flexor Carpi Radialis Tendon Rupture as a Complication of a Closed Distal Radius Fracture: A Case Report

Although extensor pollicis longus tendon ruptures have been noted as a complication of distal radius fractures, flexor tendon ruptures in association with acute fractures of the distal radius are rare. We report a rupture of the flexor carpi radialis tendon as a complication of an acute distal radius fracture that was discovered during operative management of the fracture.

Incidence and characteristics of distal radius fractures in a southern Swedish region

BackgroundThe incidence of distal radius fracture has increased substantially during the last 50 years according to several studies that estimated the overall incidence in various general populations. The incidence of fracture classified according to severity has not been well documented. The aim of this population-based study was to estimate the overall and type-specific incidence rates of distal radius fracture in a representative population in southern Sweden.MethodsDuring 2001, all persons older than 18 years with acute distal radius fracture in the southern Swedish region of Northeastern Scania were prospectively recorded. A radiologist classified the fractures according to the AO system and measured volar tilt and ulnar variance. A fracture with volar tilt outside a range of -5° to 20° and/or ulnar variance of 2 mm or greater was defined as displaced.Results335 persons with acute distal radius fracture were recorded during the 1-year period. The overall incidence rate was 26 (95% confidence interval 23–29) per 10,000 person-years. Among women the incidence rate increased rapidly from the age of 50 and reached a peak of 119 per 10,000 person-years in women 80 years and older. The incidence rate among women 50 to 79 years old (56 per 10,000 person-years) was lower than that reported in previous studies of similar populations. Among men the incidence rate was low until the age of 80 years and older when it increased to 28 per 10,000 person-years. Fractures classified as AO type A comprised about 80% of the fractures in women and 64% in men. Almost two-thirds of all fractures were displaced and among men and women 80 years and older more than 80% of the fractures were displaced.ConclusionThe incidence rate of distal radius fracture in women 50 to 79 years old was lower than previously reported, which may indicate declining incidence in this group. In both sexes, the incidence was highest in the age group of 80 years and older. With a growing number of elderly in the general population, the impact of distal radius fracture in the future may be considerable.

A cadaver model to evaluate the accuracy and reproducibility of plain radiograph step and gap measurements for intra-articular fracture of the distal radius

The purpose of this study was to determine the accuracy and reproducibility of intra-articular step-off and gap displacements measured on plain radiographs using a standard cadaver model. Twenty-two physicians, in a blinded randomized fashion using a standard technique, examined the radiographs of 12 unique combinations of step and gap displacement created by a 3-part intra-articular osteotomy of the distal radius. Observer accuracy, inter- and intraobserver agreement, and tolerance limits were calculated. The results of this study suggest that observers, independent of skill level, may measure step-off and gap displacements accurately to within .62 +/- .53 mm (95% confidence interval = .59-65). The accuracy of measurement was influenced by the quality of the radiograph. Intraclass correlation coefficient scores showed "substantial" (.78) to "almost perfect" (.81) inter- and intraobserver agreement. These data can aid in the interpretation of clinical studies of acute distal radius fractures that are based on plain radiography.

Comparison of Three Immobilization Techniques in the Management of Acute Distal Radius Fractures

Comparison of Three Immobilization Techniques in the Management of Acute Distal Radius Fractures

T INCISION FOR EXPOSURE OF THE DISTAL RADIUS AND WRIST

A retrospective review of 66 T-shaped incisions for exposure of the dorsal distal radius and wrist was performed. The incision provided excellent exposure in all cases and no additional incisions were required. Cosmesis was considered acceptable by all patients. Complications occurred in 6% and were more likely in patients undergoing fixation of acute distal radius fractures using Kirschner wires which protruded through the skin flaps.